United Healthcare Insurance for Drug and Alcohol Rehab

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About United Healthcare Insurance

UnitedHealthcare is one of the largest health insurance companies, serving tens of millions of customers worldwide.1 If you or a loved one has UnitedHealthcare insurance and is considering drug or alcohol rehabilitation treatment, you’re probably wondering what is and isn’t covered. While specifics change from plan to plan, this page should give you an idea of what to expect when it comes to coverage for addiction treatment through UnitedHealthcare.

Please note: This page is intended to be a general overview of how UnitedHealthcare covers addiction and mental health services, not a comprehensive guide on the subject. For specific questions about your plan and what it covers, call 1-888-319-2606 Helpline Information or speak to a UnitedHealthcare representative directly.


United Healthcare Coverage Levels and Plans

The main types of policies United Healthcare insurance offers are:

  • Affordable Care Act (ACA) marketplace plans. These plans were developed after the ACA passed. Since an employer makes no contributions with these plans, monthly premiums tend to be higher than standard healthcare. Premiums are set based on your income and the number of members in your household.2
  • Group benefit plans. These plans are provided through your employer.3
  • Government assistance plans. These include Medicare (mostly available for seniors) and Medicaid (mostly for low-income families and individuals). UHC allows Medicare and Medicaid customers to choose plans that provide additional coverage above the minimum.4

United Healthcare Insurance Plans

United Healthcare plans fit into two categories:3

  • Open access plans. These plans typically restrict your coverage to facilities that contract directly with UnitedHealthcare. There are two plans in this category:
    • UnitedHealthcare Choice, which only covers physicians and treatment facilities within the UHC network.
    • UnitedHealthcare Choice Plus, which covers providers outside the network; however, you will pay more out-of-pocket if you take this route.
  • Preferred Provider Organization (PPO):
    • The United Healthcare PPO plan does not restrict you to providers within the network. If you choose out-of-network care, it will need to be approved beforehand and you will have to seek reimbursement from UHC afterwards. Costs for these services will be greater than choosing a UHC-network facility.

Does United Healthcare Cover Drug and Alcohol Treatment?

All the plans listed above provide coverage for substance use and behavioral health treatment. Rehabilitation services are primarily provided through:

  • Inpatient treatment, where someone stays at a facility 24 hours a day, 7 days a week, receiving treatment for drug or alcohol use disorder. Often, this is done in a hospital setting so patients can be monitored by medical staff.
  • Outpatient treatment. This is the least intensive option, which requires patients to attend a facility for a few hours several days a week.

Does UnitedHealthcare Insurance Cover Inpatient Rehab?

UnitedHealthcare benefits include coverage for inpatient treatment for alcohol or drug addiction (this may exclude certain short-term insurance plans). The level of coverage or plans available may change depending on:

  • The state of residence.
  • The employer.
  • Whether your family members are included in the plan.

As an example, let’s use the Core PPO Bronze CEMD/C42L plan to review coverage. When opting for inpatient treatment within the UHC network, your costs would break down as follows:5

  • The deductible (amount that you must pay out-of-pocket before UnitedHealthcare begins covering costs) for an individual is $6,300.
  • The coinsurance rate is 50%. Once your deductible has been reached, you will continue to have to pay half the costs until you reach your out-of-pocket maximum.
  • The out-of-pocket limit with this plan (for an individual within the UHC network) is $8,200. In many cases, with inpatient treatment, the out-of-pocket limit will be reached.

Using this same plan, if you were to choose a facility that is outside the UHC network, you’d end up paying:5

  • A deductible of $12,600.
  • The coinsurance rate of 40% (UnitedHealthcare pays 60%).
  • A maximum of $15,900. This is likely the total amount you’d owe.

Prescription drugs are often used to treat addiction and co-occurring disorders. With this plan, there is a separate deductible of $500 for prescription drugs. After which, there is a copayment for each script. Depending on the drug, the copay could be anywhere between $18 and $1,250 for prescriptions obtained through a UHC-network facility. Prescriptions obtained outside the network are not covered.5


Does United Healthcare Insurance Cover Outpatient Rehab?

UnitedHealthcare also provides coverage for outpatient drug and alcohol treatment. Once again, the specifics of your coverage will vary. Here’s an example of how costs for UHC-network outpatient treatment might be shared, this time using the Navigate EPO Bronze CDFE/C42L plan as an example:6

  • The deductible does not apply to outpatient services.
  • Each office visit costs a $65 co-payment.
  • There is no coinsurance for other outpatient services.

Prescription medication with this plan also requires a $500 deductible, and copayments range between $18 and $1,250 per script.6

The out-of-pocket maximum for this plan is $6,300.6

Out-of-network outpatient treatment or prescription medication is not covered.6


Does United Healthcare Insurance Cover Mental Health Treatment?

Substance use, behavioral health, and mental health are categorized together with UnitedHealthcare insurance plans. An inpatient stay or outpatient treatment for behavioral health or mental health reasons has the same level of coverage as treatment in an addiction center.5, 6


How to Check My United Healthcare Insurance Coverage

There are a few different ways to check your UnitedHealthcare coverage:

  • Login to the MyUHC benefits portal. Creating an account requires your:7
    • Member ID number and group policy number or your social security number (SSN) and zip code.
  • Check the benefits packet you were given by your employer when you selected an insurance plan.
  • Call customer service:8
    • Medicaid members: Use the number on your insurance card or login to the UHC community plan site.

In most cases, UnitedHealthcare insurance provides coverage for substance use and mental health services, just be sure you choose a facility that is within the UHC network, or that your plan allows you to use out-of-network facilities.

To find out if your insurance plan covers treatment at an American Addiction Centers’ (AAC) facility, you can reach out to an admissions navigator, use the “Verify Your Insurance” portal, or fill out the form below.


Sources

  1. UnitedHealthcare. (2020). About UnitedHealthcare.
  2. HealthCare.gov. (n.d.). The ‘metal’ categories: bronze, silver, gold & platinum.
  3. UnitedHealthcare. (2020). Group benefit plans.
  4. UnitedHealthcare. (2019). Coverage choices.
  5. UnitedHealthcare. (2020). Summary of benefits and coverage: what this plan covers & what you pay for covered services.
  6. UnitedHealthcare. (2020). Summary of benefits and coverage: what this plan covers & what you pay for covered services.
  7. UnitedHealthcare. (n.d.). Let’s get you registered.
  8. UnitedHealthcare. (2019). Contact us.

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